How is Tezepelumab helpful for severe asthma?

Question

Hello doctor,

I have been struggling with severe asthma that has completely disrupted my life despite strictly following my treatment plan. I am currently on the highest doses of Symbicort, Spiriva Respimat, and Montelukast, yet I still require Albuterol nebulizer treatment three to four times a day. In the past year alone, I have had seven emergency room visits and three hospitalizations, including one intensive care unit (ICU) stay where I was on a ventilator for four days. It was a terrifying experience.

My pulmonologist initially tried Xolair for eight months with minimal improvement, followed by Nucala for seven months, which slightly reduced exacerbations but did not help with daily symptoms. Now, Tezspire has been recommended, but my insurance requires proof of failure with other biologics, which has already been documented. My eosinophil count fluctuates between 420 to 680, my IgE level is 625, and allergy testing confirmed sensitivities to dust mites, mold, and pollen.

Long-term oral steroid use has severely affected my health I have gained 43 pounds, developed prediabetes, and am now showing signs of adrenal insufficiency. My pulmonary function tests (PFTs) show an FEV1 of 61 percent predicted, dropping to 42 percent during exacerbations. I had to take medical leave from my teaching job because classroom exposure triggered severe attacks. The frequent nebulizer treatments cause such intense tremors that I can barely hold a cup of coffee.

I am getting desperate. Will Tezspire be effective even though other biologics did not provide significant relief? I have heard that it works differently on asthma pathways can you confirm this? How soon might I see improvements, and what side effects should I expect?

Kindly advise.

Answer 1

Hello,

Welcome to iCliniq.

I understand your concern.

Your asthma sounds incredibly severe and disruptive, and it’s frustrating that previous biologics have not provided enough relief. Tezspire (Tezepelumab) works differently from Xolair and Nucala (omalizumab, mepolizumab), so it might still be effective for you despite the limited success with other treatments.

Xolair targets IgE, and Nucala targets IL-5 for eosinophilic asthma, whereas Tezspire blocks TSLP (thymic stromal lymphopoietin). TSLP is a key inflammatory molecule involved in multiple asthma pathways, not just eosinophilic inflammation. This means Tezspire may work even in cases where asthma is driven by various factors, such as allergies and airway remodeling.

The timeline for improvement varies. Some patients notice relief in symptoms like wheezing and nighttime awakenings within two to four weeks. Severe exacerbations typically reduce significantly by three to six months, while lung function (FEV1) may take longer to improve. Many patients report a reduced need for rescue treatments fairly early in their Tezspire treatment.

Given your low FEV1, frequent oral steroid use, and dependence on nebulizers, Tezspire could offer a good chance of stabilizing your asthma and reducing flare-ups. Clinical trials have shown a 50 to 60 percent reduction in severe exacerbations, even in patients with lower eosinophil counts or high IgE. Since your eosinophil count is 420 to 680 and IgE is 625, you fall within the range where Tezspire has shown benefits. Essentially, while other biologics target only one or two pathways, Tezspire covers multiple asthma pathways, increasing the likelihood of improvement. However, if your asthma is driven by mechanisms unrelated to thymic stromal lymphopoietin (TSLP), the benefits may be limited.

Tezspire is generally well tolerated. The most common side effects include sore throat, joint pain, and mild injection site reactions. Unlike IL-5 inhibitors (Nucala), it does not increase the risk of parasitic infections, and unlike Xolair, it does not carry a risk of anaphylaxis.

Since your insurance requires proof of failure with other biologics, your doctor can submit documentation of your ER visits, hospitalizations, oral steroid dependence, and frequent nebulizer use as evidence of inadequate asthma control.

You have been through so much, and I truly hope Tezspire brings you the relief you need. I hope this information helps. For further queries, you can consult me at iCliniq.

Take care.